Tuesday, March 31, 2009

Since she was a small child, Lucy's nights have been blighted by frightening sleepwalking episodes and night terrors, causing her to roam the house screaming in fear while still asleep.And over the past six months, these episodes have taken a turn for the worse. Lucy Clarkson, 26, has twice woken up to find herself trying to strangle her boyfriend of four years, Michael Parnes

Monday, March 23, 2009

I am a US citizen- International Medical Graduate- who will start my psychiatry residency and I am interested in pursuing sleep medicine as a fellowship. Please provide me some guidance...As a psych resident/IMG, you have 2 strikes against you, though IMG status is better than FMG status. If there is a sleep fellowship program at the place where you are doing your psychiatry residency, that sleep program is your best shot. If possible, do electives in sleep, pulmonary, and ENT during your residency (the ENT rotation may be difficult to arrange). Sleep research during residency would also be helpful.

You could start your own lab if you had access to several hundred thousand dollars; there are companies you can partner with that can help you start the lab. However, this is pretty risky.

One way to transition to sleep is to be in a practice (either solo or group) of your primary specialty. Then advertise your expertise in sleep. Make an agreement with an existing sleep lab that you can read the studies (and bill the interp fee) for the patients you send there for sleep studies- this is easy to do, most labs would be willing to make this arrangement with a BE/BC sleep doc. Gradually increase your sleep work and decrease your primary specialty. Call rural hospitals in your state and offer to go out there and see sleep patients. I made this arrangement with a small hospital about 45 minutes from Jackson MS. At first I sent the patients back to my main sleep lab in Jackson. Now the hospital has a 2 bed sleep lab that I am medical director of.As you become known as a sleep expert in your state (blogging or posting on sleep discussion forums such as the AASM forums helps), opportunities will open up. You will probably be contacted by sleep labs that will offer you medical directorships and give you a lot of studies to read in exchange for going out there periodically and seeing patients (you might have to drive several hours to outlying sleep labs).

Wednesday, March 11, 2009

Decision SummaryCMS finds that the evidence is sufficient to determine that the results of the sleep tests identified below can be used by a beneficiary’s treating physician to diagnose OSA, that the use of such sleep testing technologies demonstrates improved health outcomes in Medicare beneficiaries who have OSA and receive the appropriate treatment, and that these tests are thus reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act.Therefore:Type I Polysomnography (PSG) is covered when used to aid the diagnosis of obstructive sleep apnea (OSA) in beneficiaries who have clinical signs and symptoms indicative of OSA if performed attended in a sleep lab facility.A Type II or a Type III sleep testing device is covered when used to aid the diagnosis of obstructive sleep apnea (OSA) in beneficiaries who have clinical signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility.A Type IV sleep testing device measuring three or more channels, one of which is airflow, is covered when used to aid the diagnosis of obstructive sleep apnea (OSA) in beneficiaries who have signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility.A sleep testing device measuring three or more channels that include actigraphy, oximetry, and peripheral arterial tone is covered when used to aid the diagnosis of obstructive sleep apnea (OSA) in beneficiaries who have signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility.